Illuminated and modular soft tissue retractor

ABSTRACT

A surgical retractor for illuminating a surgical field includes an ergonomic handle, a retractor blade coupled with the handle, a quick release mechanism, and an illuminator blade. The retractor blade is adapted to engage and retract tissue, and the quick release mechanism is adapted to couple the handle with the retractor blade. The illuminator blade acts as a waveguide to transmit light by total internal reflection. Light is extracted from the illuminator to illuminate the surgical field. The retractor blade is releasable from the handle without requiring uncoupling of the illuminator blade from the handle and also without requiring optical uncoupling of the illuminator blade from a light source. The retractor may also be adapted to evacuate smoke from the surgical field.

CROSS-REFERENCE

The present application is a continuation of U.S. patent applicationSer. No. 15/439,527 filed Feb. 22, 2017 which is a continuation of U.S.patent application Ser. No. 14/872,482 now U.S. Pat. No. 9,610,130 filedon Oct. 1, 2015, which is a continuation of U.S. patent application Ser.No. 14/500,605 now U.S. Pat. No. 9,173,648 filed on Sep. 29, 2014, whichis a divisional of, and claims the benefit of U.S. patent applicationSer. No. 13/624,622 now U.S. Pat. No. 8,876,709 filed on Sep. 21, 2012,which is a non-provisional of, and claims the benefit of U.S.Provisional Patent Application No. 61/538,675 filed on Sep. 23, 2011;the entire contents of which are incorporated herein by reference.

This application is related to U.S. patent application Ser. Nos.15/598,120; 11/654,874; 11/432,898; 11/818,090; 12/750,581; 11/805,682;11/923,483; 12/191,164; 13/026,910; and Ser. No. 13/253,785; the entirecontents of each of which is incorporated herein by reference.

BACKGROUND OF THE INVENTION

Illumination of body cavities for diagnosis and or therapy is typicallyprovided by overhead lighting or by headlamps. These forms ofillumination can be challenging to use under certain situations. Forexample, overhead lighting must constantly be adjusted as thephysician's position changes relative to the patient, as well as toilluminate different parts of the surgical field. Also, overheadlighting devices may require sterile handles to be attached to thelights in order for the physician to make adjustments without breachingthe sterile field. Even then, the light provided by the overhead lampmay not illuminate the work space adequately. Head lamps can be heavyand uncomfortable to use, may require an assistant to help a physicianput the headlamp on, and they often generate considerable amounts ofheat during use which further limits comfort and can cause burns if anoperator accidently mishandles the head lamp. Head lamps also requirethe physician to constantly adjust head position in order to illuminatethe work space, and this can be uncomfortable to the physician.

In an attempt to address some of these issues, surgical instruments suchas retractors have been coupled with light pipes such as fiber optics toconduct light from a light source such as a halogen light or a LED lightsource in order to illuminate a surgical field. For example, someconventional illuminated soft tissue retractors utilize a fiber opticlight bundle attached to a retractor handle. The fiber optic bundleprovides a very focused light with a significant amount of heat. Thefiber optics tube is also typically in the line of sight of the user,thereby obstructing a surgeon's view in use. Also, the fiber opticbundle only provides a narrow spot of light and must be constantlyadjusted to illuminate the surgical field and minimize glare or shadows.Additionally, the fiber optic bundle requires precision manufacturingand polishing, and the fibers are fragile and can be easily scratched,occluded by blood or other debris, or otherwise damaged in use. Thusfiber optic bundles can also be challenging to use in illuminatedsurgical systems.

Other materials may be used as waveguides that overcome some of thechallenges associated with fiber optic bundles. Exemplary materials suchas acrylic or polycarbonate have also been used as waveguides, but thesematerials have unstable light transmission characteristics underextended use, and the transmission characteristics may change aftersterilization using conventional techniques. For example, many polymerscross-link and turn yellow or become brittle after terminalsterilization with radiation. Heat from autoclaving or ethylene oxidesterilization can deform the waveguide. Additionally, precision opticalpolymers have limited mechanical properties which can limit their use inmedical and surgical procedures. For example, some polymers are brittleand can easily shatter during use, or are difficult to process duringmanufacturing (e.g. hard to injection mold).

In addition to some of the challenges with illumination of a surgicalfield, surgical instruments such as retractor blades do not alwaysaccommodate the anatomy being treated, and the handles are not alwaysergonomically shaped for operator comfort in various positions.Conventional retractors also can interfere with electrosurgical devicesand result in unwanted electrical arcing. Also smoke or other fumescreated during electrosurgery can be toxic, and/or unpleasant anddistracting for a physician. Current smoke evacuation devices can becumbersome and obstruct visualization of the surgical process.

Therefore, it would be desirable to provide improved illuminated medicaldevices that provide better illumination of a work space and that reduceor eliminate some of the weight and heat constraints of traditionalheadlamps and overhead lighting. Such devices avoid interfering withelectrosurgical devices and can evacuate smoke or noxious fumesgenerated by the electrosurgical device while maintaining a very lowprofile so as not to obscure visualization of the surgical procedure.Such devices preferably provide superior lighting to allow visualizationof the surgical field, including adjacent tissues such as nerves orblood vessels. Additionally, it would also be desirable to provideimproved illuminated medical instruments that are easy to manufacture(e.g. do not require optical polishing, can be injection molded),sterilizable, and have desired mechanical properties in service. Itwould also be desirable to provide illuminated medical devices that areergonomically designed for operator comfort, and that can easily beadjusted or changed out with other attachments that accommodate variousanatomies and operator positions. Such devices preferably includeinterchangeable handles and attachments such as retractor blades thatcan accommodate various waveguide illuminators. It would also bedesirable to interchange handles and retractor blades with an easilyactuated release mechanism that facilitates reliable interchangeabilitywith minimal operator effort in slippery conditions which are typicallyencountered in surgery. Such instruments also have low profiles so theinstrument can fit through small incisions or be positioned in smallsurgical fields which reduce scarring, improve healing time, and reducehospital stay. At least some of these objectives will be addressed bythe embodiments disclosed herein.

SUMMARY OF THE INVENTION

The present invention generally relates to medical devices and methods,and more particularly relates to illuminated medical devices andmethods. These devices are preferably modular and can be interchangedwith different handles and blades and may have other features such asthe ability to evacuate smoke.

In a first embodiment, an illuminated and modular surgical retractor forilluminating a surgical field comprises a handle ergonomically designedto fit in a surgeon's hand, a retractor blade releasably coupled withthe handle, a quick release mechanism coupled with the handle andretractor blade, and an illuminator blade releasably coupled with thehandle and disposed adjacent the retractor blade. The retractor blade isadapted to engage tissue and retract the tissue in a retractiondirection, and the quick release mechanism is adapted to couple thehandle with the retractor blade. The illuminator blade has a light inputportion, a light conducting portion, and a light output portion, andacts as a waveguide to transmit light from the light input portionthrough the light conducting portion to the light output portion bytotal internal reflection. Light is extracted from the light outputportion to illuminate the surgical field. The retractor blade isreleasable from the handle in a direction transverse to the retractiondirection, and also without requiring uncoupling of the illuminatorblade from the handle. The retractor blade is also releasable from thehandle without requiring optical uncoupling of the illuminator bladefrom a light source. The light source may be an external light sourcesuch as a halogen light, or the light source may be an LED that may becoupled to or integrated into the handle. Rechargeable or disposablebatteries may be disposed in the handle for energizing the light source.The light source may also be programmable to provide different lighting.

The handle may comprise a proximal end and a distal end, and the handlemay further comprise a flared region adjacent the proximal end tofacilitate handling by the surgeon. The handle may also comprise otherergonomic features such as scalloped regions adjacent the proximal end,a hub disposed adjacent the proximal end thereof that is releasablycoupled to the handle, or a textured outer surface. The textured surfacemay comprise a plurality of finger grooves disposed circumferentiallyaround the handle that are adapted to facilitate handling of the handleby a physician. The handle may comprise a substantially cylindricalbody, and also may have a first channel extending between the proximaland distal ends thereof that are sized to receive a cable for opticallycoupling the light input portion of the illuminator blade with the lightsource. The handle may comprise a plurality of cable positioningapertures disposed adjacent the proximal end of the handle, and theapertures may be sized to slidably receive the cable for opticallycoupling the illuminator blade with the light source. The handle mayalso have a second channel that extends between the proximal and distalends thereof, and that is sized to receive a suction tube that fluidlycoupled the retractor blade with a source of vacuum. The cablepositioning apertures may communicate with the first channel and disposethe cable laterally to a side of the handle. The retractor blade mayalso be pivotably coupled with the handle. The handle may also bemodular such that different proximal, distal, or middle portions may beconnected together to form a custom handle that ergonomically fits in anoperator's hand, has the appropriate length or shape to fit the anatomybeing treated, and has the appropriate mechanical and electricalelements for coupling with other retractor blades or illuminator blades.

The retractor blade may be formed from a metal such as stainless steelor aluminum, or it may be injection molded from a polymer or compositematerial. The blade may comprise a plurality of vacuum channels disposedtherealong, and the handle may have a second channel extending betweenthe proximal and distal ends thereof, sized to receive a suction tubefor fluidly coupling the plurality of vacuum channels with a vacuumsource. The retractor blade may comprise at least one vacuum channeldisposed therein. The illuminator blade may be disposed in a channel inthe retractor blade and may be sealingly engaged with the retractorblade to prevent vacuum leakage along seal. The retractor blade maycomprise one or more channels therein for delivering a vacuum, and acover may be disposed thereover in sealing engagement. The cover may beslidably engaged with the retractor blade or it may be fixedly coupledthereto. The retractor blade may have a constant cross-sectionalgeometry or it may change from proximal to distal ends. For example, thethickness may decrease distally, and the width may increase or decreasedistally. The retractor blade may have a channel for receiving theilluminator blade and the channel depth may decrease until the channeldisappears and becomes flush with the retractor blade surface on adistal portion of the retractor blade.

The illuminator blade may be an optical waveguide that transmits lighttherethrough via total internal reflection. The optical waveguide may bea non-fiber optic waveguide that may be injection molded and thereforeis a single integral component fabricated from a single homogenousmaterial such as polycarbonate, polymethyl methacrylate, cylco olefinpolymer or cyclo olefin copolymer.

The retractor blade may comprise a distal tip that is releasably coupledto a distal portion of the retractor blade and that is adapted to engageand grasp tissue during retraction. The retractor blade may comprise anextension blade that is releasably coupled to a distal portion of theretractor blade. The distal tip may comprise a textured surface and maybe curved upwards in the retraction direction. The distal tip may have acovering disposed thereover, and the covering may have a texturedsurface adapted to engage and grasp tissue during retraction. Theretractor blade may comprise an alignment feature disposed on theretractor blade or on the handle, and this alignment feature is adaptedto linearly align the retractor blade with the handle during engagementtherebetween. The alignment feature may comprise a rail disposed on theretractor blade or the handle. The retractor blade may have a proximalregion and a distal region, and the proximal region may be disposed in afirst plane substantially parallel with the handle, and the secondregion in a second plane transverse to the first plane. A portion of theretractor blade may be electrically insulated.

The quick release mechanism may comprise an engagement element disposedon either the handle or the retractor blade, and the mechanism may alsohave a receptacle on the other of the handle or the retractor blade. Thereceptacle may be sized to receive the engagement element. Theengagement element may be slidably received in the receptacle or it maybe rotatably engageable with the receptacle. The engagement element maycomprise a T-shaped bar rotationally engageable with the receptacle, orit may comprise an enlarged head, and the receptacle may have a flangedportion sized to receive the enlarged head. The quick release mechanismmay comprise an actuator mechanism for sliding or otherwise moving theengagement element between engaged and disengaged positions. The engagedor disengaged positions may comprise a switch or lever or otheractuation mechanism that is retracted or advanced into position. In theadvanced position the engagement element may be coupled with thereceptacle. The engagement element may be biased to return to theretracted position. The quick release mechanism may comprise a detent oneither the handle or the retractor blade, and the mechanism may alsocomprise a receptacle for receiving the detent on the other of thehandle or retractor blade. The quick release mechanism may furthercomprise a locking mechanism for locking the quick release mechanism toprevent disengagement of the retractor blade from the handle. Thelocking mechanism may have a rotatable cam having a first position and asecond position. In the first position the rotatable cam preventsactuation of the quick release mechanism thereby preventingdisengagement of the retractor blade from the handle, and in the secondposition, the rotatable cam allows actuation of the quick releasemechanism thereby permitting disengagement of the retractor blade fromthe handle. The quick release mechanism may comprise a rotatable leverdisposed on either the handle or the retractor blade, and the rotatablelever may have a first position and a second position. In the firstposition the lever prevents slidable movement between the retractorblade and the handle, and in the second position the lever permitsslidable movement between the retractor blade and the handle. Thesurgical retractor may further comprise a suction tube that is fluidlycoupled with the retractor blade, and the quick release mechanism maycomprise an aperture disposed in the retractor blade for receiving thesuction tube.

The retractor blade may comprise a channel extending from a proximal endthereof toward a distal end thereof, and the illuminator blade may bedisposed in the channel. The illuminator blade may have active zones anddead zones. Light passes through the active zones by total internalreflection, and substantially no light passes through the dead zones bytotal internal reflection. The illuminator blade may have engagementelements in the dead zones that allow the illuminator blade to bedisposed against the retractor blade while maintaining an air gapbetween active zones of the illuminator blade and the retractor blade.The light input portion of the blade illuminator may also compriseactive zones and dead zones. Light passes through the active zones bytotal internal reflection, and substantially no light passes through thedead zones by total internal reflection. The light input portion maycomprise a cylindrical proximal portion adapted to be coupled with alight source, and a rectangular distal portion optically coupled withthe light conducting portion. A shield having a collar may be disposedover the cylindrical proximal portion such that an air gap is maintainedtherebetween. The shield may be disposed over the light conductingportion. The shield preferably protects the blade illuminator fromdamage caused by other surgical instruments in the surgical field andalso preferably shields a physician from glare emitted from the bladeilluminator. The shield may comprise a tab that is adapted to releasablycouple the blade illuminator with the handle. The light output portionmay comprise a plurality of surface features for extracting light fromthe blade illuminator and for directing the extracted light laterallyand/or distally toward the surgical field. Some of the surface featuresmay comprise parallel prism shapes with a primary facet and a secondaryfacet. The light input portion may comprise a generally cylindricalinput zone transitioning to a generally rectangular neck. The bladeilluminator may have a width and a thickness, and the width may begenerally greater than the thickness. The light input portion may bedisposed in a plane substantially parallel with the handle, and thelight output portion may be in a plane transverse thereto. The surgicalretractor may further comprise a light input cable optically andreleasably coupled with the light input portion of the bladeilluminator. The light input cable optically couples the bladeilluminator with the light source.

The surgical retractor may further comprise a vacuum channel forextracting smoke from the surgical field. The vacuum channel maycomprise a plurality of channels disposed in the retractor blade thatare also fluidly coupled with a vacuum source. A first cover or vanewhich may be integrated into the waveguide may be disposed over thechannels thereby forming a plenum therebetween for extracting the smokewhile maintaining the minimal profile. A second cover or vane may bedisposed over the channels. The first cover may be disposed end-to-endwith the second cover, or it may be disposed on top of the second cover,or the two covers may have a joint connecting them together. The firstcover or the second cover may be linearly slidable relative to thechannels thereby adjusting vacuum strength. The first cover may comprisea plurality of apertures extending therethrough, and the second covermay be slidably disposed over the first cover such that vacuum strengthmay be adjusted by sliding the second cover relative to the first coverto adjust exposure of the apertures. The retractor blade may comprise anelongate channel, and the first cover and the second cover may bedisposed in the channel. The first and second covers may be slidablydisposed in a slot in the retractor blade. A vacuum hose may be disposedin the handle and it may be coupled with the retractor blade so that thevacuum hose fluidly couples the plurality of channels with the vacuumsource. The vacuum hose may need to be uncoupled from the retractorblade prior to disengagement of the retractor blade from the handle. Thesurgical retractor may also have a pivot mechanism coupled with thehandle. The pivot mechanism allows adjustment of an angle between theretractor blade and the handle.

In another aspect of the present invention, a surgical method forretracting soft tissue comprises providing a handle with an illuminatorblade coupled thereto, selecting a retractor blade from a plurality ofretractor blades, and releasably coupling the retractor blade with thehandle. The method also includes the steps of positioning the retractorblade in a surgical field, illuminating the surgical field with lightextracted from a light output portion of the illuminator blade, whereinlight is transmitted from a proximal end of the illuminator blade to thelight output portion by total internal reflection, retracting the softtissue with the retractor blade in a retraction direction, and releasingthe retractor blade from the handle in a direction transverse to theretraction direction. The retractor blade is released from the handlewithout requiring uncoupling of the illuminator blade from the handle,and the retractor blade is released from the handle without requiringoptical decoupling of the illuminator blade from a light source.

Releasing the retractor blade may comprise actuating an actuatormechanism, releasing a detent mechanism, rotating a lever, ordisengaging the retractor blade in a direction toward a distal end ofthe retractor blade. The cable may optically couple the light sourcewith the blade illuminator, and releasing the retractor blade from thehandle may not require decoupling of the cable from the bladeilluminator. The retractor blade may also be released from the handle byrotating the retractor blade relative to the handle. A suction tube maybe uncoupled from the retractor blade and retracted through the handlein order to release the retractor blade from the handle. Coupling theretractor blade with the handle may comprise sliding an enlarged headinto a receptacle, and the enlarged head may be disposed on theretractor blade or the handle with the receptacle being disposed on theother of the retractor blade or the handle. The method may furthercomprise locking the retractor blade with the handle after couplingtherebetween, or unlocking the retractor blade from the handle prior torelease therebetween.

The method may also include releasably coupling a hub with a proximalportion of the handle. Other aspects of the method may include pivotingthe retractor blade relative to the handle, and extracting smoke fromthe surgical field. The smoke may be evacuated from the surgical fieldby applying suction through a plurality of channels in the retractorblade. Suction strength may be adjusted by moving a plate over theplurality of channels to control exposure thereof. The method may alsocomprise coupling or decoupling a distal retractor tip with theretractor blade. A cover may be applied to a distal portion of theretractor blade and the cover may have surface features that are adaptedto grasp tissue. The cable may be positioned laterally to one side ofthe handle by positioning the cable in one of a plurality of cablepositioning apertures disposed adjacent a proximal end of the handle.

These and other aspects and advantages of the invention are evident inthe description which follows and in the accompanying drawings.

INCORPORATION BY REFERENCE

All publications, patents, and patent applications mentioned in thisspecification are herein incorporated by reference to the same extent asif each individual publication, patent, or patent application wasspecifically and individually indicated to be incorporated by reference.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the invention are set forth with particularity inthe appended claims. A better understanding of the features andadvantages of the present invention will be obtained by reference to thefollowing detailed description that sets forth illustrative embodiments,in which the principles of the invention are utilized, and theaccompanying drawings of which:

FIG. 1 illustrates a perspective view of a soft tissue retractor.

FIG. 2 illustrates a perspective view of a handle.

FIG. 3 illustrates a cross-section of a handle.

FIGS. 4A-4B illustrate alternative cross-sections of a handle.

FIG. 5 illustrates a perspective view of the proximal end of a handle.

FIGS. 6A-6C illustrate adjustment of the retractor blade relative to thehandle.

FIG. 7A is a perspective view of a retractor blade that allowsadjustment of toe-in and toe-out.

FIG. 7B is a side view of the retractor blade in FIG. 7A.

FIG. 7C illustrates the retractor of FIG. 7A coupled to a handle, andwith an illumination blade device.

FIG. 8A illustrates a side view of a surgical retractor.

FIG. 8B illustrates an end view of the surgical retractor in FIG. 8A.

FIG. 9 illustrates a perspective view of a retractor blade.

FIGS. 10A-10B illustrate a cover disposed over the distal tip of theretractor blade.

FIG. 10C illustrates teeth on the distal tip of the retractor blade.

FIGS. 11A-11E illustrate coupling of an illuminator blade with theretractor blade and handle.

FIGS. 11F-11G illustrate various sizes of illuminator blades.

FIG. 12A is a perspective view of an illuminated retractor blade.

FIG. 12B is an exploded view of the input collar and the illuminationblade input of the illuminated retractor blade in FIG. 12A.

FIG. 12C is a cross-sectional view of the illuminator blade andretractor blade of FIG. 12A.

FIG. 12D is a side view of the illuminator blade in FIG. 12A.

FIG. 12E is a front view of the illuminator blade in FIG. 12A.

FIGS. 13A-13J illustrate a retractor blade having channels for smokeevacuation.

FIGS. 13K-13M illustrate alternative embodiments of vanes used tocontrol suction.

FIGS. 14A-14B illustrate evacuation of smoke using a retractor withchannels.

FIGS. 15A-15B illustrate an exemplary embodiment of an engagementmechanism for coupling a retractor blade with a handle.

FIGS. 16A-16D illustrate another exemplary embodiment of an engagementmechanism for coupling a retractor blade with a handle.

FIGS. 17A-17B illustrate a locking mechanism.

FIGS. 18A-18F illustrate another exemplary embodiment of an engagementmechanism for coupling a retractor blade with a handle.

FIGS. 19A-19B illustrate an alignment feature for facilitatingengagement of a retractor blade with a handle.

FIG. 20 illustrates still another exemplary embodiment of an engagementmechanism for coupling a retractor blade with a handle.

FIGS. 21A-21C illustrate coupling of a retractor blade with a handleusing the engagement mechanism in FIG. 20.

FIGS. 22A-22B illustrate another exemplary method of coupling aretractor blade and handle together using the engagement mechanism ofFIG. 20.

FIGS. 23A-23E illustrate disengagement and re-engagement of a retractorblade with a handle using the mechanism of FIG. 20.

FIGS. 24A-24E illustrate exemplary use of an illuminated surgicalretractor to retract tissue, illuminate the surgical field, and evacuatesmoke.

FIG. 25 is a perspective view of another illuminated soft tissueretractor.

FIG. 26 is a perspective view of the illuminated soft tissue retractorseen in FIG. 25.

FIG. 27 is an exploded perspective view of the illuminated soft tissueretractor of FIG. 25.

FIG. 28 is a side view of the illuminated soft tissue retractor of FIG.25.

FIG. 29 is an end view of the illuminated soft tissue retractor of FIG.25.

FIG. 30 is an exploded side view of the illumination waveguide assemblyof FIG. 27.

FIG. 31 illustrates use of the retractor in FIG. 25 to retract tissue.

FIGS. 32A-32B illustrate an alternative embodiment of an illuminatedretractor with releasable blade.

FIG. 33 illustrates another exemplary embodiment of an illuminatedretractor with releasable blade.

FIG. 34 illustrates an exemplary embodiment of a suction channel in aretractor blade.

FIGS. 35A-35D illustrate still other exemplary embodiments of a suctionchannel in a retractor blade.

DETAILED DESCRIPTION OF THE INVENTION

Modular Soft Tissue Retractor

FIG. 1 illustrates a perspective view of a soft tissue retractor 10. Theretractor 10 includes a handle 14 and a retractor blade 12 releasablycoupled to the handle 14. The retractor may be used to retract anytissue, but is preferably used to retract tissue during breast surgeryor thyroid surgery. Various retractor blades 12 may be coupled with thehandle 14 in order to accommodate variety of situations includingdifferent tissues, anatomies, and physician position. The soft tissueretractor may also include lighting elements for illuminating thesurgical field, a suction mechanism for evacuating smoke or othernoxious fumes, as well as any of the other features discussed herein.Any of the components of the soft tissue retractor (e.g. retractorblade, handle, blade illumination device, etc.) may be single-usedisposable, or they may be easily cleaned and re-sterilized for multipleuse.

Handle

The handle 14 may be a single piece of unitary construction or it mayhave several modular sections that are fixedly joined together usingtechniques known to those of skill in the art such as by welding, usingfasteners like screws, adhesively bonding, press-fitting, etc. In otherembodiments, the handle includes modular sections which the physician oroperator selects based on preference, and then the modular sections arereleasably coupled together. For example, FIG. 2 illustrates anexemplary embodiment of a modular handle having a proximal hub section18 and a distal section 28. Various hub and distal section geometriesmay be provided. In an exemplary embodiment, the proximal hub section 18preferably includes a generally cylindrical body 30 sized to comfortablyfit in an operator's hand, and having a flared proximal end 20 so thatthe handle may be firmly grasped when retracting in a proximaldirection, thereby helping to prevent the handle from slipping out ofthe operator's hand. Other handle shapes are also contemplated includingoval cross-sections, or flat surfaces. Scallops 22 on the proximalportion of the hub section 18 further help an operator grasp the handle.Finger grooves 16 may be disposed on an outer surface of either or bothof the proximal hub section 18 and the distal section 28. In preferredembodiments, the finger grooves 16 are grooves circumferentiallydisposed around the handle. The handle may also have thumb grips. Thehandle may also have a central channel 24 extending either partiallybetween the proximal and distal ends of the handle, or entirelytherebetween. The central channel allows cables or other tubing to runthrough the central channel in order to prevent the cables or tubingfrom becoming damaged, tangled or otherwise interfering with thesurgical procedure being performed. The central channel 24 may open upinto an open channel 26 near the distal end of the handle to allowcoupling with an illumination blade device as will be described below.The distal section 28 may also have a cylindrical body that is sized tofit in an operator's hand. In alternative embodiments, the hub section18 and distal section 28 are manufactured separately and then fixedlycoupled together. The handle may be fabricated out of metals such asstainless steel, cast, or it may be injection molded with a polymer.Some handles may be composite materials or may include ceramics. Handlesmay be re-sterilizable using ethylene oxide, gamma or e-beamirradiation, plasma, or autoclave sterilization. The handles may also befor single-use and disposable afterwards.

FIG. 3 illustrates a cross-section of handle 14 highlighting the centralchannel 24 extending therethrough. FIG. 4A illustrates a cross-sectionof an alternative embodiment of handle 14 having central channel 24 aswell as a second channel 42 in a wall of the handle and extendingthrough the handle from proximal to distal ends of the handle. Thesecond channel 42 be used for other cables, tubes, wires, etc. that maybe required in the surgical retractor. In preferred embodiments, thesecond channel 42 is used to hold a vacuum tube (also referred to hereinas a suction tube or vacuum line) that can be coupled with the retractorblade to provide suction for evacuation of noxious fumes or smoke,especially during electrosurgery. One of skill in the art willappreciate that any of the handle features disclosed herein may be usedin combination with one another. A fiber optic cable may also bedisposed in the second channel in order to deliver light from a lightsource to the illumination blade device. Multiple channels in the wallare also contemplated for suction tubes, fiber optics, electrical wires,or any other cables that may be used such as in FIG. 4B where a fiberoptic cable is disposed in channel 42 a and a suction line is disposedin channel 42, both channels in a sidewall of the handle 14.

FIG. 5 illustrates the proximal end of exemplary handle 14. The proximalend includes a plurality of apertures 52 through which cables such as alight input cable 56 may be passed. Light input cable 56 includes astandard optical fitting 60 such as an ACMI coupling for connecting thecable with a light source. The apertures 52 are sized to accommodatevarious cables, and allow the cables to be press fit and held inposition. This laterally displaces the cables to one side of the handle,thereby assisting with cable management and keeping the cables out ofthe way. The apertures 52 preferably are angled inward and communicatewith the central channel 24, thus the cable can be slid into the centralchannel 24 to the distal end of the handle where it may be opticallycoupled to an illumination blade device. Similarly, smaller apertures 54may also be disposed on the proximal end of the handle 14 in order toaccommodate other tubing or cables, such as a suction tube 62. Aconnector 58 such as a Luer connector allows the suction tubing to befluidly coupled with a vacuum source for smoke or fume evacuation. Thesuction tube may be advanced into the aperture 54 until the connector 58is press fit into the aperture, thereby holding the tubing in position.The smaller apertures 54 may also angle inward and merge with thecentral channel 24, or they may remain a separate channel all the waythrough the handle, such as channel 42 seen in FIG. 4.

Additionally, the handle may be coupled with a strong arm or other rigidcoupling that can hold the retractor in a desired position therebyfreeing the surgeon's or assistant's hands. The strong arm may beattached to the operating table, a wall in the operating room, or may beon a separate cart or table. Typically the strong arm is also adjustablein order to hold the retractor in various positions. Weight may also beattached to the handle in order to hold the retractor in a desiredposition.

Retractor Blade Adjustment

FIG. 6A illustrates a typical retractor blade 12 coupled to a handle 14.The blade 12 forms an angle θ relative to the handle. In FIG. 6A, theretractor blade is substantially perpendicular relative to handle 14,thus θ=90°. However, in certain circumstances, it is advantageous toadjust θ to a different angle. Thus, any of the retractors disclosedherein may have an adjustment mechanism that allows angle θ to beadjusted. This is commonly referred to as adjusting the toe-in ortoe-out of the blade. FIG. 6B illustrates how the blade may be movedoutward or distally 66 so that θ is an obtuse angle, while FIG. 6Cillustrates actuation of the retractor blade 12 inward or proximally 68so that θ is acute.

One of skill in the art will appreciate that any number of mechanismsmay be used to allow adjustment of θ. However, in a preferred embodimentof the surgical retractor, an illumination blade device is coupled withthe handle and disposed over of the retractor blade, a suction tube iscoupled with the retractor blade for smoke evacuation, and an opticalinput cable is coupled with the illumination blade device. Thus, thepivoting mechanism that allows adjustment of toe-in or toe-out mustaccommodate the suction tube and optical cable, as well as maintainingthe position of the illumination blade device relative to the retractorblade. Thus the adjustment mechanism allows the retractor blade to bepivoted without changing the relative position of the illumination bladeand retractor blade. Also, the mechanism allows the movement withoutunnecessarily straining the suction tube and illumination cable.

In one exemplary embodiment, the adjustment mechanism may comprise asplined pin disposed laterally in a distal portion of the handle 14.FIG. 7A illustrates retractor blade 12 having a splined channel 74extending laterally through the retractor blade and splined pin 72passing therethrough. The splined pin 72 also is disposed in a distalportion of handle 14. FIG. 7B is a side view of retractor blade 12highlighting the splined channel 74 in the retractor blade. When thesplined pin 72 is retracted from the splined channel 74, the retractorblade 12 may be pivoted to adjust θ. Once the desired angle is set, thepin may be placed back in the splined hole 74, thereby locking theretractor blade in position. The splines may be adjusted to any pitch,but in preferred embodiments, the splines are spaced apart so that theretractor blade may be adjusted in increments of every 5°, morepreferably every 3°, and most preferably every 2°. One of skill in theart appreciates that any pitch may be used, and thus the exemplarypitches are not intended to be limiting. The splined pin 72 may also bespring loaded so that an operator may push it out of the way to allowretractor blade adjustment, and the spring may be biased to push thesplined pin back into engagement with the splined hole 74 to lock theretractor blade into the desired angle. FIG. 7C illustrates theretractor blade 12 coupled with handle 14, and with blade illuminationdevice 1209 coupled to the retractor blade. Splined pin 72 is moreclearly illustrated in this view.

Retractor Blade

FIG. 8A illustrates a side view of surgical retractor having a handle 14and a retractor blade 12. In this exemplary embodiment, the retractorblade 14 is disposed in a plane that is transverse to the plane in whichthe handle 14 lies. In the embodiment of FIG. 8A, the retractor blade isperpendicular to the handle. The retractor blade 12 includes a distaltip 82 that may be curved upward towards the proximal end of the handle.Any of the surfaces of the retractor blade and/or the distal tip may betextured in order to facilitate grasping of tissue during retraction.FIG. 8B illustrates an end view of the retractor blade in FIG. 8A. Anupper surface 88 of the retractor blade may be concave, and a slottedregion or channel 86 may extend along the length of the retractor blade.This slotted region accommodates the lighting elements that aredescribed herein. Additionally, a plurality of channels 84 may run alongthe length of the retractor blade 12 and the channels 84 can be used tosuction smoke or fumes from the surgical field as will be described ingreater detail below. The length of the retractor blade, width andthickness can be any dimension suitable for the target anatomy.Preferably, several different retractor blades are provided so that theoperator may select the retractor blade most suited for the procedure.Additionally, the retractor blade may also include wings 90 on eitherside of the retractor blade 12, such as in FIG. 9. The wings 90 helpincrease the area of the retractor blade, thereby allowing more tissueto be retracted, as well as helping to keep tissue from slipping off theretractor blade during retraction. FIG. 9 also illustrates how in someembodiments, the distal tip 82 of the retractor blade may be removableso that it may be replaced with a distal tip better suited for thesurgical procedure being performed. These tips may be provided sterile.The distal tip may be press fit, snap fit, or otherwise mechanicallycoupled to the retractor blade. In other embodiments, the distal tip isfixedly attached to the retractor blade. The distal tip may have anynumber of geometries that help retract tissue. For example, the distaltip may curve upwards or it may be flat and planar. The distal tip mayalso include a textured surface 94 to help with grasping tissue duringretraction. The texturing may be machined directly into the distal tip82, or in other embodiments, the texturing may be removably attached tothe distal tip. Exemplary texturing may include knurling, teeth, orroughened surfaces. A rubberized surface may also be used to help tissueretention. Additionally, the anti-slip features may be removably appliedto the retractor blade using a textured tape, plastic sleeve, fabricsock, or polymer tip. In still other embodiments, the retractor blademay include fenestrations including holes or slots that help to catchtissue that is disposed in the fenestrations during retraction. Theretractor blade may also have a hole or slot therethrough that exposesthe rear surface of the blade illuminator. The blade illuminator mayhave protuberances that are integral with the blade illuminator or thatare attached thereto and that protrude through the retractor blade holeor slot to help secure the blade illuminator to the retractor blade.

FIG. 10A illustrates a surgical retractor having a handle 14 withretractor blade 12 and a removable distal tip 82. A cover 102 may beplaced over the distal tip 82 in order to allow different surfacetextures to be applied to the distal tip. The cover may be removed afterthe surgical procedure and discarded in order to facilitate cleaning andre-sterilization of the retractor if re-useable. In some embodiments,some or all components of the surgical retractor may be single-use anddisposed of after use. FIG. 10B illustrates the distal tip 82 of theretractor blade 12 once the cover 102 has been disposed thereover. Instill other embodiments, the retractor blade may have fixed orretractable barbs that help grasp tissue. FIG. 10C illustrates anotherembodiment where the distal tip of the retractor blade 12 includes teeth83 for helping to grasp tissue, or to facilitate dissection of tissuewith the retractor blade.

Retractors are often used in conjunction with electrosurgical equipment.Because the retractor blades are in close proximity to theelectrosurgical probe, unwanted arcing can occur between the retractorblade and electrosurgical probe. It is therefore desirable to insulateall or a portion of the retractor blade. This may be accomplished byfabricating the retractor blade from a non-conductive material such as apolymer or a ceramic, or the blade may be made from a metal and thencovered with a non-conductive coating such as a polymer like parylene oranodized. Any of the features of the retractor blade disclosed hereinmay be used with any of the other embodiments of retractor bladesdescribed elsewhere.

Illumination Blade Device

FIGS. 11A-11E illustrate coupling of an illumination blade device withthe retractor and the handle. In FIG. 11A, the retractor blade 12 isalready coupled with the handle 14, although the retractor blade may becoupled after the illumination device has been coupled with the handle.A distal portion of handle 14 includes a slot 1104 for releasablyattaching the illumination device with the handle 14. A channel or slot1102 in retractor blade 12 allows the illumination blade device to bedisposed therein. In FIG. 11B, the illumination blade device 1108 iscoupled to cable 56 thereby optically coupling the illumination bladedevice 1108 with a light source (not shown). In other embodiments, alight pipe or optical fibers may be fixedly coupled to the handle andthe illumination blade device may be coupled to a distal end of thelight pipe or optical fibers, and the proximal end of the handle is thencoupled with a light source. Thus, the cable need not be fed all the waythrough the handle.

The illumination blade device 1108 preferably includes a light outputzone 1116 where light is extracted from the illumination blade anddirected toward the surgical field. Additionally, the engagementelements such as tabs 1110 in dead zones of the illumination bladedevice allow the blade illuminator 1108 to be disposed against theretractor blade while maintaining an air gap between the active zones ofthe illuminator blade and the retractor blade, as will be discussed ingreater detail below. Additionally a shield 1112 disposed over a portionof the blade illumination device prevents it from being scratched ordamaged by other surgical instruments being used, as well as preventingglare from shining back into an operator's face. A plate 1114 allows theblade illuminator to be snapped or otherwise releasably coupled with thehandle by placing the plate 1114 into slot 1104. FIG. 11C is aperspective view of the surgical retractor after the illumination bladedevice has been coupled with the handle. Cable 56 is exposed near adistal portion of the handle in an open channel 26, but eventually runsthrough the channel 24 in handle 14 until the cable exits the proximalend of the handle through a positioning aperture 52 as seen in FIG. 11E.The cable 56 can then be optically coupled with a light source. FIG. 11Dis a top view of the surgical retractor showing the illumination bladedevice coupled with the handle and engaging the retractor blade.

FIGS. 11F-11G illustrate various sizes of illuminator blades 1108disposed in a channel of the retractor blade 12. The illuminator blades1108 may have a width that extends across the width of the retractorblade channel as seen in FIG. 11F, or the illuminator blade 1108 may benarrower than the channel as seen in FIG. 11G. Additionally, theilluminator blade length may be any length—from longer than theretractor blade, to shorter than the retractor blade, or it may the samelength as the retractor blade.

FIG. 12A more clearly illustrates engagement of the illuminator bladedevice (also referred to herein as an illuminator blade) with theretractor blade. Illuminated retractor 1207 is composed of retractorblade 1208 and illumination blade 1209. Retractor blade 1208 may be usedwith any of the embodiments disclosed herein, or it may be used withother retractor systems such as a McCulloch retraction system. Retractorblade 1208 includes one or more mechanical connectors and may bereleasably coupled with any of the handles described in thisspecification. Any of the coupling mechanisms disclosed herein may beused. Neck slot or channel 1210 accommodates neck zone 1224 of theilluminator blade 1209 and blade slot 1211 accommodates output blade1225 of the illuminator blade 1209 while maintaining an air gap betweenactive zones of the illumination blade and the retractor. Two or moreengagement elements such as blade or plate 1212 and tabs 1214 secureillumination blade 1209 to retractor blade 1208. Each tab 1214 engagesone or more engagement receptacles such as receptacles or recesses 1215.Plate 1212 is joined to collar 1216, and when collar 1216 removablyengages input dead zone 1222D, the collar surrounds illumination bladeinput 1218 as seen in FIG. 12C. The removable engagement of collar 1216to input dead zone 1222D also brings plate 1212 into contact with endsurface 1219 of the retractor blade. Collar 1216 securely engages deadzone 1222D and surrounds cylindrical input zone 1220 and forms input airgap 1220G. Engagement at dead zones minimizes interference with thelight path by engagement elements such a plate 1212 and tabs 1214. Plate1212 engages end surface 1219 and tabs 1214 resiliently engage recesses1215 to hold illumination blade 1209 fixed to retractor blade 1208without contact between active zones of illumination blade 1209 and anypart of retractor blade 1208.

Illumination blade 1209 is configured to form a series of active zonesto control and conduct light from illumination blade input 1218 of thecylindrical input zone 1220 to one or more output zones such as outputzones 1227 through 1231 and output end 1233 as illustrated in FIGS.12D-12E. Illumination blade 1209 also includes one or more dead zonessuch as zones 1222D, 1226D and 1226E. Dead zones are oriented tominimize light entering the dead zone and thus potentially exiting in anunintended direction. As there is minimal light in or transiting deadzones by total internal reflection they are ideal locations forengagement elements to secure the illumination blade to the retractor.

Light is delivered to illumination blade input 1218 using anyconventional mechanism such as a standard ACMI connector having a 0.5 mmgap between the end of the fiber bundle and illumination blade input1218, which is 4.2 mm diameter to gather the light from a 3.5 mm fiberbundle with 0.5 NA. Light incident to illumination blade input 1218enters the illumination blade through generally cylindrical, activeinput zone 1220 and travels through active input transition 1222 to agenerally rectangular active retractor neck 1224 and through outputtransition 1226 to output blade 1225 which contains active output zones1227 through 1231 and active output end 1233. Neck 1224 is generallyrectangular and is generally square near input transition 1222 and theneck configuration varies to a rectangular cross section near outputtransition 1226. Output blade 1225 has a generally high aspect ratiorectangular cross-section resulting in a generally wide and thin blade.Each zone is arranged to have an output surface area larger than theinput surface area, thereby reducing the temperature per unit outputarea.

In the illustrated configuration illumination blade 1209 includes atleast one dead zone, dead zone 1222D, generally surrounding inputtransition 1222. One or more dead zones at or near the output of theillumination blade provide locations to for engagement elements such astabs to permit stable engagement of the illumination blade to theretractor. This stable engagement supports the maintenance of an air gapsuch as air gap 1221 adjacent to all active zones of the illuminationblade as illustrated in FIG. 12C. Neck zone 1224 ends with dimension1232 adjacent to output transition 1226 which extends to dimension 1234at the output zones. The changing dimensions result in dead zones 1226Dand 1226E adjacent to output transition 1226. These dead zones aresuitable locations for mounting tabs 1214 to minimize any effects of theengagement elements on the light path.

To minimize stresses on the light input and or stresses exerted by thelight input on the illumination blade, the engagement elements arealigned to form an engagement axis such as engagement axis 1236 which isparallel to light input axis 1238.

Output zones 1227, 1228, 1229, 1230 and 1231 have similar configurationswith different dimensions. Referring to the detailed view of FIG. 12D,the characteristics of output zone 1227 are illustrated. Each outputzone is formed of parallel prism shapes with a primary surface or facetsuch a primary facet 1240 with a length 1240L and a secondary surface orfacet such as secondary facet 1242 having a length 1242L. The facets areoriented relative to plane 1243 which is parallel to and maintained at athickness or depth 1244 from rear surface 1245. In the illustratedconfiguration, all output zones have the same depth 1244 from the rearsurface.

The primary facets of each output zone are formed at a primary angle1246 from plane 1243. Secondary facets such as facet 1242 form asecondary angle 1247 relative to primary facets such as primary facet1240. In the illustrated configuration, output zone 1227 has primaryfacet 1240 with a length 1240L of 0.45 mm at primary angle of 27 degreesand secondary facet 1242 with a length 1242L of 0.23 mm at secondaryangle 88 degrees. Output zone 1228 has primary facet 1240 with a length1240L of 0.55 mm at primary angle of 26 degrees and secondary facet 1242with a length 1242L of 0.24 mm at secondary angle 66 degrees. Outputzone 1229 has primary facet 1240 with a length 1240L of 0.53 mm atprimary angle of 20 degrees and secondary facet 1242 with a length 1242Lof 0.18 mm at secondary angle 72 degrees. Output zone 1230 has primaryfacet 1240 with a length 1240L of 0.55 mm at primary angle of 26 degreesand secondary facet 1242 with a length 1242L of 0.24 mm at secondaryangle 66 degrees. Output zone 1231 has primary facet 1240 with a length1240L of 0.54 mm at primary angle of 27 degrees and secondary facet 1242with a length 1242L of 0.24 mm at secondary angle 68 degrees. Thus, theprimary facet 1240 in preferred embodiments forms an acute anglerelative to the plane in which the rear surface 1245 lies, and thesecondary facet 1242 in preferred embodiments forms an obtuse anglerelative to the plane in which the rear surface 1245 lies. Thesepreferred angles allow light to be extracted from the illuminator bladeso that light exits laterally and distally toward the surgical field inan efficient manner, and the illuminator blade to be injection moldedand easily ejected from the mold. Other angles are possible, as will beappreciated by one of skill in the art.

Output end 1233 is the final active zone in the illumination blade andis illustrated in detail in FIG. 12D. Rear reflector 1248 forms angle1249 relative to front surface 1250. Front surface 1250 is parallel torear surface 1245. Terminal facet 1251 forms angle 1252 relative tofront surface 1250. In the illustrated configuration, angle 1249 ispreferably 32 degrees and angle 1252 is preferably 95 degrees. Thisdistal tip geometry helps to prevent light from reflecting backproximally toward the physician, thereby helping to prevent glare.

Other suitable configurations of output structures may be adopted in oneor more output zones. For example, output zones 1227 and 1228 mightadopt a concave curve down and output zone 1229 might remain generallyhorizontal and output zones 1230 and 1231 might adopt a concave curveup. Alternatively, the plane at the inside of the output structures,plane 1243 might be a spherical section with a large radius ofcurvature. Plane 1243 may also adopt sinusoidal or other complexgeometries. The geometries may be applied in both the horizontal and thevertical direction to form compound surfaces.

In other configurations, output zones may provide illumination at two ormore levels throughout a surgical site. For example, output zones 1227and 1228 might cooperate to illuminate a first surgical area and outputzones 1229 and 1230 may cooperatively illuminate a second surgical areaand output zone 1231 and output end 1233 may illuminate a third surgicalarea. This configuration eliminates the need to reorient theillumination elements during a surgical procedure.

Smoke Evacuation

Many surgical retractors are used in conjunction with electrosurgicalinstruments such as RF probes for cautery. Electrosurgical instrumentsoften generate smoke or other noxious fumes that can obstruct the fieldof view or be unpleasant. Therefore, surgical retractors may alsoinclude a feature for smoke evacuation. Often, smoke or noxious fumesare evacuated with a vacuum tube that is either separate from theretractor, or coupled with the retractor. A vacuum line is coupled tothe vacuum tube, and the smoke or fumes may be evacuated. Thedisadvantage of these systems is that the separate vacuum tube takes upprecious space in the already crowded surgical field. With incisionsbecoming smaller and smaller, it is becoming more important to reducethe volume of surgical instruments. Therefore it would be advantageousto provide a surgical retractor that can evacuate smoke or fumes withouttaking up additional space.

FIGS. 13A-13C illustrate an exemplary embodiment of a retractor havingan integral smoke evacuation system. In FIG. 13A, the retractor includeshandle 14 and retractor blade 12. The handle 14 and blade 12 may be anyof the handles or blades disclosed herein. The retractor blade 12includes a plurality of longitudinal channels 1302 running along thelength of the blade. While only one channel is required, preferredembodiments have multiple channels. When a single wide channel isincluded, it is possible for other surgical instruments to get caught inthe channel, between the retractor blade and any vanes or illuminationblades that are disposed thereover. Thus, it can be advantageous to usemultiple narrow channels to minimize the opportunity for the instrumentsto catch. The channels may be parallel with one another, or othergeometries are also possible. The illumination blade device, (alsoreferred to as a blade illuminator or illumination blade) may then besealingly disposed over the channels and coupled with the retractorblade to form a gap or plenum between the channels and the bottomsurface of the illuminator blade. A vacuum tube may then be coupled withthe retractor blade so that fumes are drawn out of the surgical fieldalong the plenum. Thus, smoke is evacuated without requiring anadditional tube that occupies space in the surgical field. Depending onthe size and length of the illuminator blade being used to provide lightto the surgical field, the blade may not cover the channels enough toallow adequate vacuum to be created for effective smoke evacuation.Thus, in some cases, as seen in FIG. 13B, a cover or vane 1304 may bedisposed over the channels to accommodate different illuminator blades,as well as to control the amount of vacuum created. The cover or vane1304 may be press fit into the retractor blade and disposed over thechannels 1302 to form the plenum, or the vane 1304 may be slidablyadvanced along slots in the retractor blade. In still other embodiments,the vane 1304 may be coupled with the blade illuminator. The bladeilluminator and vane is then coupled with the retractor blade such thatthe vane covers enough area of the channels to create adequate vacuumfor smoke evacuation while maintaining an air gap between an uppersurface of the vane and a lower surface of active zones of theilluminator blade in order to minimize light loss. FIG. 13C illustratesthe blade illuminator 1306 disposed over the vane 1304 which is thenpositioned over the plurality of channels 1302. The bottom surface ofthe vane may fit flush against the top surface of the channels toprevent surgical instruments from catching. Similarly, in embodimentswhere the blade illuminator is disposed directly over the channelswithout a vane, the tip of the blade illuminator may also fit flushagainst the top surface of the channels to prevent other surgicalinstruments from catching. Thus the plenum is formed by assembly of thevane(s) and/or illuminator blade with the retractor blade. A channelsuch as channel 42 (seen in FIG. 4) may run through the handle wall andexit at a distal aperture 1308 of the handle 14. A vacuum tube may beslidably disposed in the channel 42 and exit aperture 1308 and becoupled to retractor blade 12 so that the plurality of channels 1302 arefluidly coupled with the vacuum tube. In this or other embodiments, thevacuum tube may automatically fluidly connect with the retractor bladewhen the retractor blade is engaged with the handle. Thus separatecoupling and uncoupling of the vacuum tube may not be required.

In situations where a long retractor blade 12 is used, the vane 1304 maynot be long enough to cover the channels 1302 in the retractor blade 12.This prevents adequate vacuum from being generated. Thus, in someembodiments, a second vane 1310 may be disposed against the retractorblade 12 to control the area of the channels 1302 which are covered andform the plenum. The second vane may be slidably engaged with slotsalong the retractor blade sides as seen in FIG. 13D, or the second vanemay be simply snap fit or otherwise disposed against the retractorblade. A gap is maintained between the bottom of the second vane and thechannels so that smoke or fumes may be evacuated. FIG. 13E illustratesthe second vane 1302 positioned against the first vane 1304. The twovanes may abut one another end-to-end as seen in FIG. 13F, or a jointsuch as a scarf joint may be used to couple the ends as seen in FIG.13G. Many other joints may also be used. In some embodiments, the twovanes may be slidably disposed over one another as seen in FIG. 13H.

In either embodiment with one or two vanes, the vanes may be slidablymoved along the longitudinal axis of the retractor blade. Thus someportions of the fume channels will be covered and others will beuncovered. The uncovered portions will allow fume extraction from thatposition. Thus, by sliding the vanes, the location of fume extractionmay be controlled. This is advantageous in deep pockets where proceduresare performed at multiple levels. Thus it may be advantageous to extractsmoke from a first level and then smoke may be extracted from a secondlevel.

Once the blade illuminator and vanes have been positioned against theretractor blade 12, the light source cable 56 may be coupled to theblade illuminator, and suction tube 62 coupled to the retractor blade asseen in FIG. 13I. FIG. 13J illustrates the proximal end of handle 14with the light input cable 56 and suction tube 62 extending through thehandle as previously described above. One of skill in the art willappreciate that the illuminator blade, handle, retractor blade, lightinput cable, suction tube, etc. in the embodiment of FIGS. 13A-13J maybe substituted for any of the other embodiments of illuminator blade,handle, retractor blade, light input cable, suction tube, etc. disclosedherein.

In an alternative embodiment, a first vane 1360 may have a plurality ofthrough holes 1362, as seen in FIG. 13K. The first vane 1360 is disposedagainst the retractor blade and also against the plurality of channels.A second vane 1364 is slidably disposed over the first vane 1360 as seenin FIG. 13L. The second vane 1364 may be slidably advanced or retractedrelative to the first vane as indicated by arrow 1366 in order tocontrol how many of the apertures are exposed, thereby controlling theamount of suction provided by the vacuum. FIG. 13M illustrates analternative embodiment of the first vane 1370 having a tapered slot 1372passing through the vane. As the second vane is advanced or retracted,the amount of the slot exposed varies, thereby controlling the suctionprovided by the vacuum.

FIGS. 34 and 35A-35D illustrate alternative embodiments of the vacuumchannels which may be used in any of the embodiments of illuminatedretractors with smoke evacuation disclosed in this specification. Thechannels may be machined into the part, or they may be injection moldedif the blade is molded. FIG. 34 illustrates the retractor blade 3402having internal channels 3404 (as opposed to the open channels in theembodiment of FIG. 13A-13M). Suction holes are formed through an outersurface of the retractor blade until they are fluidly coupled with theinternal channels 3404. The internal channels 3404 may be a singlechannel or a plurality of channels. Preferably the channels merge into asingle channel near the proximal portion of the retractor blade so thatthe suction may be applied to the retractor blade at a single point.FIGS. 35A-35B illustrate a retractor blade with multiple open channels.For example in FIG. 35A, an open channel 3504 a is disposed in theretractor blade 3502 a. Two channels merge into a single channel nearthe proximal end of the retractor blade. A sliding cover or vane 3506 aslides over the open channel to allow vacuum to be created and so thatsuction can be applied through suction holes 3508 a in the cover 3506 a.FIG. 35B illustrates a similar embodiment with the major exception beingthat the cover or vane 3506 b is fixedly coupled to the retractor blade3502 b. Multiple vacuum channels are internal to the retractor blade.Vacuum is then drawn through suction holes 3508 b in the cover. FIGS.35C and 35D illustrate embodiments of retractor blades with a singleopen vacuum channel. In FIG. 35C a single open vacuum channel 3504 isdisposed in the retractor blade 3502 c. A slidable cover or vane 3506 cmay be placed over the channel into engagement with the retractor bladeto seal the vacuum channel and allow vacuum to be drawn through suctionholes 3508 c in the cover. FIG. 35D illustrates a similar embodimentexcept that the cover 3506 d is fixed to the retractor blade 3502 d.Vacuum is applied through the single open channel 3504 d and throughsuction holes 3508 d in the cover. Additionally, as disclosed in greaterdetail in this specification, the blade illuminator may seal against theretractor blade to create the vacuum. Any of these embodiments may beused in the illuminated retractors with smoke evacuation featuresdisclosed herein.

FIG. 14A illustrates a perspective view of the retractor in FIGS.13A-13J. Smoke 1402 generated by electrosurgery or other noxious fumesis drawn into channels 1302 and then evacuated via a suction tubedisposed in aperture 1308 in the handle 14. FIG. 14B illustrates abottom view of the retractor blade 12 evacuating smoke 1302.

In alternative embodiments, the smoke evacuation channels may beintegrated into the blade illumination device rather than in theretractor blade, or in still other embodiments the evacuation channelsmay be disposed in both the blade illumination device and the retractorblade. Other embodiments may rely on a gap between the vane and a bottomsurface of the blade illumination device to create a plenum that allowssmoke evacuation.

Retractor Blade and Handle Engagement

Any number of quick release mechanisms for engaging the retractor bladewith the handle may be used. The quick release mechanism, or engagementmechanism should be easy to actuate, and in some embodiments allows onehanded actuation for one handed engagement or disengagement of theretractor blade from the handle. The mechanism preferably still permitsthe handle and retractor blade to be easily cleaned and re-sterilizedafter use. In still other embodiments, the mechanism along with otherparts of the retractor including the handle, retractor blade andilluminator blade are single use disposable. The engagement mechanismpreferably allows release of the retractor blade from the handle withoutrequiring that any cables (e.g. light input cables) or tubes (e.g.suction tubes) be disconnected from the handle. Additionally, themechanism preferably allows the retractor blade to be disengaged fromthe handle without requiring the blade illuminator to be disconnectedfrom the handle. Several embodiments of quick release mechanisms aredisclosed herein for exemplary purposes, and they are not intended to belimiting. Any of the quick release mechanisms described herein may beused with any of the other components or features described herein. Forexample, any of the quick release mechanisms described herein may beused with any of the handle, retractor blade, illuminator blade, orsmoke evacuation embodiments disclosed herein.

FIGS. 15A-15B illustrate an exemplary embodiment of a quick releasemechanism for coupling the handle 14 with the retractor blade 12. Inthis exemplary embodiment, the quick release mechanism includes anactuator switch 1502 that is slidably actuated as indicated by arrow1504. The switch 1502 has two positions, an engaged position and adisengaged position. FIG. 15A illustrates the switch in the engagedposition wherein the handle 14 is locked with the retractor blade 12.FIG. 15B illustrates the switch in the disengaged position which allowsthe handle 14 to be released from the retractor blade 12. The actuatormechanism advances and retracts an engagement element 1508 such as acentral post having an enlarged head or flanged region that is receivedin a slot 1506 on the retractor blade 12. When the switch is actuatedinto the engaged position, the enlarged head is pressed further into thereceiving slot 1506 creating a friction fit preventing separation of thetwo components. Actuating the switch into the disengaged positionslightly retracts the head from the receiving slot 1506 relieving thefriction fit and allowing separation of the two components. Theretractor blade is then released from the handle by advancing theretractor blade in a plane transverse to the handle, and in thedirection of the distal end of the retractor blade. One of skill in theart will appreciate that the switch may also work in the oppositedirection.

FIGS. 16A-16D illustrate another exemplary embodiment of a quick releasemechanism for engaging the handle and retractor blade. FIG. 16A showsthe retractor blade 12 disengaged from the handle 14. The engagementmechanism includes a post 1604 having lateral projections forming aT-shaped head 1602 or an enlarged head on the proximal end of theretractor blade. The T-shaped head 1602 is advanced toward a receptacle1606 with the lateral portions vertically aligned so that the T-shapedhead 1602 is received in slot 1606. Once the enlarged head is receivedin the slot, retractor blade 12 may be rotated 1608 so that the lateralprojections of the T-shaped head 1602 become captured in the receptacle1606. In preferred embodiments, only a quarter turn is required toengage the retractor blade and handle as seen in FIG. 16C. FIG. 16D moreclearly illustrates how the lateral projections of the T-shaped head1602 are captured in slot 1612. Ball detents 1610 disposed on thereceptacle press against the lateral projections, thereby holding themin place. Release of the retractor blade from the handle follows thereverse procedure. A quarter turn rotation of the retractor bladerelative to the handle releases the lateral projects from the balldetents and disposes them vertically so that the retractor blade may beretracted through the slots in the receptacle and separated from thehandle. This embodiment preferably only requires a quarter turn forengagement or disengagement, however other geometries allow more or lessrotation of the retractor blade relative to the handle.

In the embodiment of FIGS. 16A-16D, an optional locking mechanism mayalso be used to lock the engagement mechanism and prevent inadvertentseparation of the retractor blade from the handle. For example, in FIG.17A a rotating cam 1620 is disposed adjacent the T-shaped head 162 andreceptacle 1606. Once the T-shaped head has engaged the receptacle 1606,the cam 1620 may be rotated 1626 to lock the engagement mechanism. Thecam has a round portion 1622 and a flat portion 1624. When the flatportion 1624 is adjacent the receptacle 1606 as seen in FIG. 17A, theflat portion does not obstruct the slot and thus the enlarged head maybe placed in or removed from the receptacle. However, when the cam isrotated such that the round portion is adjacent the receptacle, theround portion obstructs the slot, thereby preventing the enlarged headfrom sliding out of the receptacle, thereby ensuring that it is locked.FIG. 17B illustrates the cam in the locked position.

FIGS. 18A-18F illustrate another exemplary embodiment of an engagementmechanism for coupling a retractor blade with a handle. FIG. 18A showsthe handle 14 having an engagement element 1802 extending from thedistal end of the handle. The engagement element preferably has acentral post with an enlarged head or flanged region attached to thecentral post. A spring loaded ball detent 1804 is disposed on theengagement element 1802. The retractor blade 12 includes a slottedregion 1806 that has a geometry that is sized and shaped to receive thecentral post and enlarged head. A receptacle (not illustrated) in theslotted region 1806 is sized to receive the ball detent 1804. FIG. 18Bmore clearly illustrates the engagement mechanism. Thus, in operation,the retractor blade is advanced toward the handle and the proximal endof the retractor blade is slidably loaded over the central post andenlarged head so that they are received in the slot on the retractorblade. A slight upward force is applied to the retractor blade so thatthe ball detent then snaps into its corresponding receptacle, therebyengaging the retractor blade and handle together. The retractor blade inthis embodiment is raised in a plane that is transverse to, andpreferably substantially parallel to the handle plane for engagement.FIG. 18C illustrates engagement of the handle and retractor blade andalso shows the central post 1802 and enlarged head 1804 disposed in thereceiving slot 1806. Either before engagement of the retractor blade andhandle, or after, the blade illumination device 1108 with or withoutshield 1112 may be coupled with light input cable 56 and then coupledwith the handle 14 and retractor blade 12. Also suction tube 62 may beslidably disposed in the handle and coupled with the retractor blade aspreviously discussed. The retractor blade may be removed using thereverse procedure. By sliding the retractor blade downward in a planetransverse and preferably substantially perpendicular to the plane ofthe handle, the ball detent will disengage from its correspondingreceptacle, and then the retractor blade may be dropped downward awayfrom the handle and disengaged. Thus, the retractor blade may bedisengaged without requiring any cables (e.g. light input cable) orblade illumination devices to be removed. The suction tube 56 helpsprevent disengagement of the retractor blade from the handle andtherefore must be retracted proximally to disconnect it from theretractor blade. Another advantage of this mechanism as well the othersdisclosed herein is that the retractor blade can also be removed fromthe handle without touching the blade illumination device. Thismechanism is advantageous because it allows the retractor blade to beseparated from the handle easily, without disconnecting cables (such aslight input cable 56), nor does the blade illumination device 1108 orshield 1112 need to be uncoupled from the handle, as seen in FIGS.18E-18F where the retractor blade is released away from the bladeillumination device and cable 56.

An alternative embodiment of that in FIGS. 18A-18F includes handle 14having an engagement element 1802 extending from the distal end of thehandle. The engagement element preferably has a central post with anenlarged head or flanged region attached to the central post. It mayinclude spring loaded ball detent 1804 which is disposed on theengagement element 1802. The retractor blade 12 includes a slottedregion 1806 that has a geometry that is sized and shaped to receive thecentral post and enlarged head. A receptacle (not illustrated) in theslotted region 1806 is sized to receive the ball detent 1804. Once theretractor blade is engaged with the handle, suction tube 62 may beslidably advanced into engagement with the retractor blade therebycoupling the handle with the retractor blade and preventing unwantedseparation. Removal of the suction tube allows the retractor blade to beseparated from the handle in a similar manner as previously described.

FIGS. 19A-19B illustrate an alignment feature that may be used with theembodiment in FIGS. 18A-18D or with any of the other embodimentsdisclosed herein. One side of the distal end of the handle 14 mayinclude a rail 1902, and a mating rail 1904 may also be included oneside of the proximal end of the corresponding retractor blade 12. Thus,as the retractor blade is advanced toward and engaged with the handle,the two rails 1902, 1904 will contact one another and slide relative toone another. This helps ensure proper alignment of the retractor bladeand handle. It also provides a key mechanism that ensures that theretractor blade is inserted in the proper orientation, and notbackwards. FIG. 19A shows the retractor blade disengaged from thehandle, and FIG. 19B shows the two components engaged, with thealignment rails engaged with one another.

FIG. 20 illustrates another exemplary embodiment of an engagementmechanism for coupling any of the retractor blades and handles disclosedherein together. Additionally, any of the other features such as bladeillumination devices, suction, etc. may also be used with thisembodiment. Handle 14 includes an engagement element 2002 extendingdistally from the distal portion of the handle. The engagement element2002 includes a central post and an enlarged head or flanged areasimilar to that described above. A slot 2010 on the proximal end of theretractor blade 12 is sized and shaped to receive the engagementelement. Unlike the embodiment described previously, this embodimentdoes not have a spring loaded ball detent on the engagement mechanism,but alternative embodiments may include it. A rotatable lever 2004 iscoupled to the distal end of the handle, and a spring loaded ball detentis included on a portion of the lever. Other features such as the smokeevacuation channels 1302, alignment rails 1902, 1904, vacuum port 1308generally take the same form as previously described. FIG. 20 alsoillustrates an aperture 2008 in the retractor blade which is alignedwith vacuum portion 1308 when assembled so that the channels 1302 arefluidly coupled with the vacuum. In use, the retractor blade may beraised into engagement with the handle such that the alignment element2002 is received in slot 2010. The lever 2004 is then rotated from anunlocked position (pointing down in this embodiment) to a lockedposition (rotated outward) to lock the retractor blade into engagementwith the handle. The ball detent 2006 snaps into a receptacle (notillustrated) on the retractor blade and provides adequate force toprevent accidental disengagement of the lever. Additional details on theengagement mechanism are disclosed in greater detail below.

The engagement mechanism of FIG. 20 allows a retractor blade to becoupled with the handle either before or after a blade illuminationdevice has been coupled with the handle. The engagement mechanism allowsthe attachment and detachment of the retractor blade without requiringthe operator to touch the blade illumination device, and cables such asthe light input cable need not be disconnected. FIGS. 21A-21C illustratean embodiment where the blade illumination device is coupled with thehandle before the retractor blade is coupled with the handle. In FIG.21A, the blade illumination device 1108 is attached to the handle 14 andlight input cable 56 is also optically coupled with the bladeillumination device. The blade illumination device generally takes thesame form as the embodiment in FIGS. 12A-12E, and may be attached to thehandle in the same manner as described above in FIGS. 11A-11E. Theembodiment in FIG. 21A also includes vane 1304 attached to a portion ofshield 1112. The vane 1304 may be any of the embodiments of previouslydescribed above and used to create a plenum for smoke evacuation. Thelever 2004 is in the disengaged position, and then the retractor blade12 is advanced toward the handle as illustrated in FIG. 21B. The bladeillumination device 1108 and vane 1304 are slidably disposed in acentral channel of the retractor blade, and the retractor blade israised vertically relative to the handle. The retractor blade is raisedin a plane transverse to the plane of the handle, and preferablysubstantially perpendicular to the handle. Once the retractor blade isaligned with the handle and the blade illumination device is properlydisposed adjacent the retractor blade, the lever 2004 may be rotatedinto the engaged position as seen in FIG. 21C thereby locking theretractor blade with the handle.

In alternative embodiments, the retractor blade may be attached to thehandle first, then the blade illumination device may be coupled with thehandle as seen in FIGS. 22A-22B. In FIG. 22A, retractor blade 12 isengaged with handle 14 and the lever 2004 is rotated into the lockedposition, similarly as described above. The blade illumination device1108 with shield 1112 is then coupled with the handle and disposedagainst the retractor blade. Cable 56 then optically couples the bladeillumination device 1108 with a light source.

FIGS. 23A-23E illustrate more clearly how the mechanism in FIG. 20allows quick release of a retractor blade with a handle. In FIG. 23A,retractor blade 12 is already engaged with handle 14. Lever 2004 is inthe engaged position which forms a horizontal surface against whichshoulder 2302 rests, preventing the retractor blade from slidablydisengaging from the handle. The blade illumination device 1108 withshield 1112 is snapped into the handle and disposed against theretractor blade. Cable 56 optically couples the blade illuminator devicewith the retractor blade. Suction tube 62 is in fluid communication withthe retractor blade via aperture 1308 to allow smoke or fumes to beevacuated from the surgical field. Suction tube 62 prevents the rotationof the lever thereby locking the lever into the engaged position. Whenthe operator desires to change the retractor blade, the suction tube 62is proximally retracted as seen in FIG. 23B so that it is released fromaperture 1308. Engagement lever 2004 is then rotated in FIG. 23C intothe release position, here rotated counter clockwise into a six o'clockposition so that the lever is no longer engaged with shoulder 2302 ofthe retractor blade. The lever is also out of the path of the shoulder2302 so that retractor blade slides downward away from the handle 14,and the engagement element 2002 is released from slot 2010. Theretractor blade is disengaged in a plane transverse to the plane of thehandle, and preferably substantially parallel thereto. This is also in adistal direction toward the distal end of the retractor blade. Lightfrom the illumination blade device is also extracted and directed inthis direction. The retractor blade may be disengaged from the handlewithout touching the blade illumination device 1108 and withoutrequiring cables such as light input cable 56 to be disconnected fromthe blade illumination device. Also, the blade illumination device 1108with vane 1304 does not have to be disconnected from the handle duringretractor blade change out. FIG. 23D shows disengagement of theretractor blade from the handle with the blade illumination deviceremaining coupled to the handle. Once the original retractor blade isremoved, a second retractor blade may be slid back into position andengaged with the handle as seen in FIG. 23E using the oppositeprocedure. Once engaged, the lever 2004 may be rotated to lock theretractor blade with the handle by forming a shelf that preventsshoulder 2302 from moving. The suction tube 62 is then re-advanced intoapertures 1308 and coupled with the retractor blade. Again, this processis performed without touching the blade illumination device or requiringdisconnection of any cables as discussed above, and the bladeillumination device may remain coupled to the handle during theengagement.

Other engagement mechanisms may be used to releasably couple theretractor blade with the handle. For example, spring clasps with orwithout latches, sliding prongs, and threaded fasteners may also beused. FIGS. 32A-32B illustrate another exemplary embodiment of anilluminated retractor with a releasably blade. The retractor includes ahandle 14, a blade 3202, and a blade illuminator 3210. The handle 14includes a flanged portion 20 to help the physician retract tissue andchannels 3216, 3218 for a suction tube and a fiber optic respectively inthe wall of the handle 14. A blade illuminator 3210 is either fixedly orreleasably coupled to the handle 14 and optically coupled with a fiberoptic cable disposed in channel 3218. The retractor blade 3202 includesa vacuum channel 3206 in the blade and vacuum holes 3204 which allownoxious fumes and smoke to be drawn into the vacuum channel 3206. Theretractor blade 3202 is pivotably coupled to the handle 14 so that theretractor blade has a retracted position (seen in FIG. 32A) and anextended position (seen in FIG. 32B). In the retracted position, theretractor blade lies substantially parallel with the handle body 14.When the retractor blade is pivoted outward away from the handle, theretractor blade is extended preferably into a position that isorthogonal to the handle plane where it locks into position with detentsor other locking mechanisms well known in the art. Once the retractorblade locks into the extended position, the blade is substantiallyparallel to the blade illuminator. Additionally a vacuum fitting 3208 onthe retractor blade couples with a port 3218 on the handle that iscoupled with the suction lumen 3216. Thus, when the retractor blade isextended, the suction automatically is coupled with the handle.Additionally, the retractor blade may retract into engagement with theblade illuminator and the two elements may snap together. In analternative embodiment, the vacuum channel is an open channel, and theretractor blade sealingly engages the illuminator blade thereby sealingthe channel so that suction may be applied to the vacuum holes 3204.Retractor blade fits in the space 3214 created between the bladeilluminator and the distal end of the handle. Once the retractor bladeis extended, it may be inserted into a surgical field for retraction oftissue. Light 3220 is extracted from the blade illuminator via surfacefeatures 3212 and directed toward the surgical field. The retractorblade may also be releasably coupled with the handle so that it may bereplaced with a retractor blade having a different configuration. Any ofthe features of previously embodiments may be combined with orsubstituted with features of the embodiment in FIGS. 32A-32B. Similarly,features of the embodiment in FIGS. 32A-32B may be used in any of theembodiments disclosed elsewhere in this disclosure.

FIG. 33 illustrates still another exemplary embodiment of an illuminatedretractor with a releasable retractor blade. The handle 14 and flange 20generally take the same form as previous embodiments. A bladeilluminator 3202 is also fixedly or releasably coupled to the handle 14along with a short section 3206 of a retractor blade having a vacuumchannel 3208 and a fitting 3210. The short section 3206 may be shorterthan, the same length as, or longer than the blade illuminator 3202.Various length and geometry retractor blade extensions 3212 a, 3212 b,3212 c can then be coupled with the short section 3206 depending on theanatomy being treated. Fittings 3216 on the various retractor bladeextensions 3212 a, 3212 b, 3212 c allow the retractor blade to bereleasably coupled with fitting 3210 and with the short section 3206 ofthe retractor blade. The suction lumen 3208 in the short section 3206may be coupled with the suction lumen 3214 a, 3214 b, 3214 c in theextensions. A suction line in the handle 3204 is coupled with thesuction lumen 3208 in the short section and may be coupled to anexternal source of vacuum. Any of the features of this embodiment may besubstituted with or combined with features of any of the otherembodiments disclosed herein. Similarly, any of the features in thisembodiment may be used in any of the other embodiments disclosed herein.

Surgical Method

Once a preferred retractor blade 12 and handle 14 have been selected andengaged using any of the engagement mechanisms described herein, andpreferably a blade illumination device 1108 is coupled to the handle anda light input cable 56 optically couples the blade illumination devicewith a light source, the retractor may be used to retract tissue,illuminate the surgical field, and evacuate smoke or fumes therefrom asseen in FIGS. 24A-24E.

FIG. 24A illustrates the assembled retractor being positioned adjacentan incision I. The retractor may be used to retract any tissue, butpreferably is used to retract soft tissue such as in breast or thyroidsurgery. In FIG. 24B, the distal tip of the retractor blade is advancedinto the incision, and in FIG. 24C, the retractor blade is retractedproximally, here in a vertical direction to retract tissue and create apocket 2402. Surgical instruments, equipment, as well as the surgeon'shands may be placed in the pocket 2402 to perform diagnostic ortherapeutic procedures. Since it will be difficult to see in the pocket,the blade illumination device 1108 is also advanced into the pocket asthe retractor blade is inserted into the pocket, thereby illuminatingthe pocket as seen in FIG. 24D. Additionally, electrosurgicalinstruments 2404 such as cautery devices may be used during theprocedure as seen in FIG. 24E, and this may generate smoke or othernoxious fumes which can be evacuated using the smoke features previouslydescribed above. The physician may change retractor blades at any timeduring the procedure in order to accommodate various anatomies,retraction direction, as well as physician position. As mentionedbefore, any of the features previously described herein may be used inthis exemplary method, and thus one of skill in the art will appreciatethat any number of combinations or substitutions are possible.

Thyroid Retractor

The surgical retractor embodiments described above are preferably usedfor retraction of soft tissue during procedures such as breast surgery.The following alternative embodiments are similar to those previouslydescribed, but have modifications that are preferable for accommodatingsoft tissue retraction in other anatomies and procedures, such as duringthyroid surgery. The following embodiments may be combined with orsubstituted with any of the features previously described above. Forexample, any of the handle, retractor blade or blade adjustment featuresmay easily be incorporated into the embodiments described below.Additionally, the illumination blade features, smoke evacuation, andblade-handle engagement mechanisms may also be used in the embodimentsdescribed below. Thus, one of skill in the art will appreciate that anycombination of the features described above may be used with orsubstituted for any of the features described herein. Similarly, any ofthe features described below may be used with or substituted with theembodiments previously described above.

Referring to FIG. 25, illuminated soft tissue retractor 2510 includesretractor assembly 2512, illumination waveguide assembly 2514 andillumination assembly 2515. Proximal projection 2517 extends generallyperpendicular from retractor body 2512A. Retractor blade 2512B iscoupled with a distal portion of the retractor body 2512A and mayinclude a proximal portion that generally lies in the same plane as theretractor body 2512A, and a distal portion which is transverse thereto.In some embodiments, the distal portion of the retractor blade isorthogonal to the proximal portion of the retractor blade, althoughother angles may be used. Proximal projection 2517 optimizes applicationof counter traction without the need for squeezing retractor body 2512Awhich often leads to fatigue. Proximal projection 2517 may be weightedto balance the instrument as well as enabling the retractor to providecounter traction by itself. Proximal projection 2517 may be formed ofheavier material than retractor body 2512A or retractor blade 2512B.Alternatively, one or more weights may be secured within proximalprojection 2517 such as weights 2516 (best seen in FIG. 28) to controlthe location of center of mass 2525 as shown in FIG. 28. The weights2516 maybe releasably connected to the proximal projection 2517 bydisposing the weights in a plurality of apertures. The weights may bethreadably engaged, press fit, or otherwise coupled with the proximalprojection. The apertures may also be machined or otherwise formed intothe proximal projection for proper weighting of the assembly.

The configuration of proximal projection 2517 further enablesself-retraction by including a generally flat foot or surface 2518 toprevent rolling and sliding of the retractor when it is providingself-retraction. Retractor body 2512A includes channel 2519 toaccommodate and engage illumination assembly 2515 within the generalprofile of retractor body 2512A. The illumination assembly 2515preferably includes a cable for optically coupling the waveguideassembly 2514 with a light source (not illustrated). A proximal end ofthe illumination assembly 2515 optically may include a standard opticalconnector such as an ACMI connector for coupling the cable with thelight source.

Referring now to FIG. 26, retractor assembly 2512 has a distal end 2512Dand a proximal end 2512P. Proximal end 2512P includes proximalprojection 2517, and distal end 2512D includes retractor blade 2512B.Retractor blade 2512B includes waveguide socket 2520 for engagingillumination waveguide assembly 2514. One of more additional waveguidesecuring elements may also be included such as clip socket 2521 forfurther engaging illumination waveguide assembly 2514 and maintainingtotal internal reflection (TIR) of the light conducted through thewaveguide by minimizing contact between retractor blade 2512B andwaveguide assembly 2514. When contact between retractor blade 2512B andwaveguide assembly 2514 cannot be eliminated, transmission efficiency ismaintained by controlling where contact is made and minimizing thepossibility of light escaping at the point(s) of contact. The waveguidemay have active zones where light is transmitted through the waveguideby total internal reflection, and dead zones where substantially nolight is transmitted by total internal reflection. Contact between thewaveguide and the retractor blade is preferably limited to the deadzones of the waveguide in order to minimize light loss. Additionally, inpreferred embodiments, an air gap is maintained between the active zonesof the waveguide and the retractor blade, again to minimize light loss.

Referring now to FIG. 27, waveguide assembly 2514 includes waveguide2514W which is configured to provide optimal light conduction usingtotal internal reflection (TIR) of the incident light introduced throughlight input 2522. Light input 2522 preferably has a round or cylindricalinput transitioning into a square or rectangular section that is thencoupled with the remainder of the waveguide. This transition zonecreates dead zones in the square or rectangular portion of the lightinput 2522 where substantially no light is transmitted by TIR, and thusthis portion of the waveguide may be coupled to the clip 2527 in orderto minimize light loss due to contact between the waveguide and theclip. The use of TIR provides optimal efficiency and enables maximumlight available and optimal direction of light 2523 at first outputsurface 2524 and second output surface 2526 (best seen in FIG. 30).Light from the first output surface 2524 preferably is directed distallyand laterally from the waveguide to illuminate the surgical field asindicated by the arrows emanating from output surface 2524. Configuredfor use, waveguide 2514W may engage a clip such as clip 2527 forsecuring waveguide 2514W to the retractor blade connections such as clipsocket 2521. The clip also allows a light input cable (not illustrated)to be releasably coupled with the light input 2522, and the clip alsomaintains an air gap around the cylindrical or round portion of theinput 2522 to maximum light transmission efficiency. One or more shieldssuch as light shield 2528 may also be included in waveguide assembly2514. The shield may be coupled with the clip 2527 to prevent directcontact with the waveguide, and the shield helps to protect thewaveguide from damaged caused by other instruments in the surgicalfield, as well as shielding the operator from glare which may shine backinto his/her eyes. FIG. 30 illustrates a side view of the waveguideassembly 2514 seen in FIG. 37.

Referring now to FIG. 28, retractor assembly 2512 includes retractorbody 2512A and retractor blade 2512B. Retractor blade 2512B is joined toretractor body 2512A at transition zone 2529 along interface 2513.Transition zone 2529 is configured to create drop angle 2530 betweenblade axis 2532 and retractor axis 2534. Drop angle 2530 is ideallybetween 5 and 35 degrees although any other suitable angle may be used.For thyroid surgery, drop angle 30 is about 15 degrees. Retractor bladelength 2536 and retractor blade depth 2537 may adopt any suitabledimensions depending on the type of surgery anticipated. For thyroidsurgery, blade length of 30 to 50 mm and blade depth of 25 to 60 mm arecurrently preferred. Of course, any dimensions may be used, and theexemplary ranges are not intended to be limiting. The inclination angle,angle 2538, of the retractor blade may adopt any suitable angle. Forthyroid surgery, blade inclination angle 38 of 90 degrees is currentlypreferred.

Retractor blade 2512B has a proximal end 2540 which is secured toretractor body 2512A at interface 2513. Distal end 2542 of the retractorblade is configured for optimal utility in minimally invasive surgery.Retractor blade 2512B is generally narrow along depth 2537. In minimallyinvasive procedures it becomes important to enable tools to perform morethan one function to save time and minimize movements of the surgicalteam. Distal end 2542 is configured with a trapezoidal tip 2543. In theprocedure outlined below and in other procedures, an illuminated softtissue retractor such as retractor 2510 may be used for blunt dissectionas well as tissue retraction. Around delicate structures it is necessaryto control the amount of force applied to the tissues being dissectedand extending tip width 2544 expands the area of contact with the tissuebeing retracted and lessens the force per unit area applied to thetissue being retracted.

Retractor body 2512A may also include a source of illumination such aslight 2546 and a portable source of energy such batteries 2547 togenerate illumination. FIG. 29 illustrates a front perspective view ofthe retractor in FIG. 28.

Illuminated soft tissue retractor 2510 may be used to perform manydifferent minimally invasive and open surgical procedures. The followingexample of a thyroid procedure is by way of example and is not limiting.In practice, the illuminated soft tissue retractor is used to perform aminimally invasive thyroidectomy as described below.

FIG. 31 illustrates an illuminated retractor such as the embodimentdescribed in FIGS. 25-30 above used in a thyroid procedure. Theretractor 2512 is inserted into an incision I and is used to retracttissue T as described in greater detail below. This creates space forthe surgeon to work and also allows surgical instruments S to beinserted into the surgical field such as an electrocautery device.

The patient is placed the supine position. Arms padded and tucked at thepatient's side. A shoulder roll is placed to extend the neck and a foamdonut placed to provide head support. A pillow is placed under thepatient's knee and thigh high sequential hose applied. The head of theO.R. table is raised about 10 degrees and the foot lowered 10 degrees.The patient is then prepped and draped. Drapes are placed allowingaccess from the suprasternal notch to the chin and laterally to themargins of the sternocleidomastoid muscles.

After draping the cricoid cartilage is located by palpation. A skinmarker is used to mark the incision no more than 1 cm below the cricoidcartilage and 3-4 cm long. If the incision is made lower than 1 cm thethyroid superior poles will be more difficult to dissect. The incisionis made with a #15 blade through the skin and underlying platysmamuscle. Double prong skin hooks are used to retract and lift thesuperior skin flap. A Kelly clamp is used to dissect the subplatysmaplane. The inferior platysma plane is dissected in the same fashion.Grasping the proximal projection, the illuminated thyroid retractor isnow used to retract the superior skin flap and illuminate the surgicalsite. The connective tissue between the strap muscles may be readilyidentified due to the improved illumination in the surgical site.Dissection is performed through the connective tissue with a Kelly clampand electrocautery. The strap muscles are dissected both superiorly andinferiorly. Blunt dissection is utilized along with traction-countertraction to mobilize the strap muscles from the thyroid. A peanut spongeis used for blunt dissection. Similarly, the distal end of theilluminated soft-tissue retractor may be used for blunt dissection withimproved visualization of adjacent structures owing to the illuminationfrom the TIR waveguide. The blade of the illuminated thyroid retractoris placed under the strap muscles and the proximal projection is pulledlaterally to provide the necessary counter traction.

The proximal projection provides a suitable location for application ofcounter traction without requiring the fatiguing tension that must oftenbe applied to conventional retractors. At this point the overheadsurgical lights do not provide adequate light. The illuminated softtissue retractor provides the light necessary to continue the procedurein the surgical cavity. Careful blunt dissection is continued withcounter traction to sweep the adherent connective tissue from thethyroid lobe. This dissection is done medially to far lateral thusmobilizing the thyroid from the adjacent structures including thecarotid artery.

Dissection of the thyroid superior pole is now performed with a peanutsponge and counter traction with the illuminated thyroid retractor. Oncethe connective tissue is dissected the thyroid lobe is retractedinferiorly and medially. The space between the thyroid gland andcricothyroid muscles is identified. A Kelly clamp and peanut sponge isused to free the thyroid gland from the cricothyroid muscle. A Babcockclamp is placed on the gland to aid retraction and place tension on thesuperior pole. A Kelly clamp is used to identify and dissect thesuperior pole vessels. The superior parathyroid gland is also identifiedand dissected at this time. Counter traction and illumination ismaintained with the illuminated thyroid retractor while the superiorpoles vessels are ligated.

Once the superior pole vessels are ligated the thyroid lobe is reflectedmedially and superiorly. The illuminated thyroid retractor isrepositioned laterally to expose the lateral and inferior structures ofthe thyroid gland. Peanut sponges are used to dissect the remainingconnective tissue. A Mosquito clamp is used to dissect and identify theinferior parathyroid gland, thyroid vessels, and the recurrent laryngealnerve. Meticulous dissection is required to avoid injury to therecurrent laryngeal nerve. Remaining thyroid vessels are ligated. Theconnective tissue between the thyroid gland and trachea are dissectedwith a Mosquito clamp and peanut sponges. The dissection is continuedmedially to the Ligament of Berry. A Mosquito clamp is used to dissectand clamp the Ligament of Berry. Sharp dissection with a #15 blade andthe remaining tissue is ligated. (The same technique is then performedin the same order on the opposite lobe). Once the thyroid resection iscompleted hemostasis is obtained. The strap muscles are re-approximatedwith 3-0 absorbable suture. The dermis is closed with 5-0 absorbablesuture. A 5-0 subcutiular suture is used to close the skin. Any suitableop-site dressing is used to dress the wound.

Traction-countertraction is a technique used to provide tissuedissection and visualization of the recurrent laryngeal nerves andparathyroids in a minimally invasive thyroid surgery as described above.It is critical that these structures are preserved and not injuredduring the thyroidectomy surgery. The traction-countertraction techniqueis conventionally accomplished by using a USA or Army-Navy retractor topull the strap muscles and carotid artery sheath away from the thyroidgland and at the same time retracting the thyroid gland in the oppositedirection.

In order to see into the surgical site a headlight may be used. Theheadlight provides a unidirectional beam of light that is aimed by thesurgeon. As the thyroid is dissected, the surgeon has to constantlychange the position of his head, neck, and upper body in order to shinethe light beam onto the different areas being dissected. Constantlyhaving to change positions adds stress to the surgeon and in someinstances he is unable to aim the light where it is needed. Thereforethe illuminated retractors described herein may be used with theheadlight or alone to illuminate the surgical field.

Illuminated soft tissue retractor 2510 has a longer and narrowerretractor blade than conventional thyroid surgery retractors. Thetrapezoidal tip flares out providing increased surface area forretraction and dissection. The proximal projection easily engages thesurgeon's hand lessening fatigue. The drop angle of 15 degrees allowsthe surgeon to retain his arm and shoulder in a more neutral positioncompared to conventional retractors. The inclusion of the TIR waveguideoptimizes tissue visualization in deep surgical sites without the use offatiguing headlamps.

In an alternate configuration, retractor assembly 2512 may be formed ofseparable elements. Retractor blade 2512B may be replaceable and may beseparated from retractor body 2512A at interface 2513.

While preferred embodiments of the present invention have been shown anddescribed herein, it will be obvious to those skilled in the art thatsuch embodiments are provided by way of example only. Numerousvariations, changes, and substitutions will now occur to those skilledin the art without departing from the invention. It should be understoodthat various alternatives to the embodiments of the invention describedherein may be employed in practicing the invention. It is intended thatthe following claims define the scope of the invention and that methodsand structures within the scope of these claims and their equivalents becovered thereby.

What is claimed is:
 1. An illuminated surgical instrument forilluminating a surgical field, said instrument comprising: a handlehaving a proximal portion, a distal portion, and a longitudinal axis; aretractor blade releasably coupled to the handle, the retractor bladehaving a first surface and a second surface, wherein the second surfaceis configured to engage and retract tissue and the first surface facesaway from the second surface; an illumination element coupled to thehandle, wherein the illumination element illuminates the surgical fieldwith light emitted from the illumination element in a directiontransverse to the longitudinal axis of the handle, and wherein theretractor blade is releasably coupled to the handle so that theretractor blade is releasable from the handle while the illuminationelement remains coupled with the handle.
 2. The instrument of claim 1,further comprising a cable coupled to a proximal portion of theillumination element, wherein the cable remains coupled to theillumination element while the retractor blade is released from thehandle.
 3. The instrument of claim 1, wherein the illumination elementcomprises a waveguide.
 4. The instrument of claim 1, wherein theretractor blade comprises a channel extending along a longitudinal axisthereof, and wherein the illumination element is disposed in thechannel.
 5. The instrument of claim 1, further comprising a quickrelease mechanism coupled to the handle, the quick release mechanismconfigured to release the retractor blade from the handle.
 6. Theinstrument of claim 1, further comprising a suction tube coupled to thehandle, the suction tube configured to remove smoke or noxious fumesfrom the surgical field.
 7. The instrument of claim 1, wherein theretractor blade is uncoupled from the handle with movement of theretractor blade in a transverse direction relative to the longitudinalaxis of the handle.
 8. The instrument of claim 1, wherein theillumination element further comprises optical structures disposedthereon, the optical structures configured to extract and direct thelight from the illumination element toward the surgical field.
 9. Theinstrument of claim 1, wherein the illumination element is releasablefrom the handle while the retractor blade remains coupled to the handle.10. An illuminated surgical instrument for illuminating a surgicalfield, said instrument comprising: a handle having a proximal portion, adistal portion, and a longitudinal axis; a retractor blade releasablycoupled to the handle, the retractor blade having a first surface andsecond surface, wherein the second surface is configured to engage andretract tissue and the first surface faces away from the second surface;an illumination element coupled to the handle, wherein the illuminationelement is configured to illuminate the surgical field with light, andwherein the retractor blade is releasable from the handle while theillumination element remains coupled with the handle, and wherein theillumination element is disposed adjacent the first surface of theretractor blade.
 11. The instrument of claim 10, further comprising acable coupled to a proximal portion of the illumination element, whereinthe cable remains coupled to the illumination element while theretractor blade is released from the handle.
 12. The instrument of claim10, wherein the illumination element comprises a waveguide.
 13. Theinstrument of claim 10, wherein the retractor blade comprises a channelextending along a longitudinal axis thereof, and wherein theillumination element is disposed in the channel.
 14. The instrument ofclaim 10, further comprising a quick release mechanism coupled to thehandle, the quick release mechanism configured to release the retractorblade from the handle.
 15. The instrument of claim 10, furthercomprising a suction tube coupled to the handle, the suction tubeconfigured to remove smoke or noxious fumes from the surgical field. 16.The instrument of claim 10, wherein the retractor blade is uncoupledfrom the handle with movement of the retractor blade in a transversedirection relative to the longitudinal axis of the handle.
 17. Theinstrument of claim 10, wherein the illumination element furthercomprises optical structures disposed thereon, the optical structuresconfigured to extract and direct the light from the illumination elementtoward the surgical field.
 18. The instrument of claim 10, wherein theillumination element is releasable from the handle while the retractorblade remains coupled to the handle.
 19. An illuminated surgicalinstrument for illuminating a surgical field, said instrumentcomprising: a handle having a proximal portion, a distal portion, and alongitudinal axis; a retractor blade releasably coupled to the handle,the retractor blade having a first surface and second surface, whereinthe second surface is configured to engage and retract tissue and thefirst surface faces away from the second surface; an illuminationelement releasably coupled to the handle, wherein the illuminationelement is configured to illuminate the surgical field with light, andwherein the illumination element is detachable from the handle while theretractor blade remains coupled to the handle, and wherein theillumination element is disposed adjacent the first surface of theretractor blade.
 20. The instrument of claim 19, further comprising acable coupled to a proximal portion of the illumination element, whereinthe cable remains coupled to the illumination element while theretractor blade is released from the handle.
 21. The instrument of claim19, wherein the illumination element comprises a waveguide.
 22. Theinstrument of claim 19, wherein the retractor blade comprises a channelextending along a longitudinal axis thereof, and wherein theillumination element is disposed in the channel.
 23. The instrument ofclaim 19, further comprising a quick release mechanism coupled to thehandle, the quick release mechanism configured to release the retractorblade from the handle.
 24. The instrument of claim 19, furthercomprising a suction tube coupled to the handle, the suction tubeconfigured to remove smoke or noxious fumes from the surgical field. 25.The instrument of claim 19, wherein the retractor blade is uncoupledfrom the handle with movement of the retractor blade in a transversedirection relative to the longitudinal axis of the handle.
 26. Theinstrument of claim 19, wherein the illumination element furthercomprises optical structures disposed thereon, the optical structuresconfigured to extract and direct the light from the illumination elementtoward the surgical field.